Abstract
Six dialyzed neurosurgical patients were presented. All these patients had craniotomy for intracranial diseases, three for intracerebral hemorrhage and the others for ruptured aneurysms. The causes for dialysis were chronic glomerulonephritis in four patients, polycystic kidneys in two. One patient was treated with continuous peritoneal dialysis (CPD) and the others were with hemodialysis (HD). The patients treated with CPD and two hemodialyzed patients died. The mortality rate was 50%. Dialysis disequilibrium syndrome (DDS) occurred in two patients on HD, one of which died for irreversible cerebral hemiation. The management of the neurosurgical patients requiring dialysis in perioperative period was discussed and reviewed in the literature. It was proposed that CPD is superior to HD at least in perioperative period to prevent bleeding tendency and DDS. Slow dialysis and maintenance of a high osmolality in plasma with intravenous mannitol or glycerol injection were effective to prevent intracranial pressure (ICP) change during HD. Continuous ventricular drainage and ICP monitoring were simple and essential methods to prevent irreversible cerebrel herniation during HD especially in comatose patients.
